Provider Demographics
NPI:1235121633
Name:BUCKLEY, RUDOLPH A (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:A
Last Name:BUCKLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-1227
Mailing Address - Country:US
Mailing Address - Phone:315-824-1250
Mailing Address - Fax:315-824-8961
Practice Address - Street 1:85 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-1227
Practice Address - Country:US
Practice Address - Phone:315-824-1250
Practice Address - Fax:315-824-8961
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210879207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1174755003OtherGROUP NPI
G10002Medicare UPIN